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Psychological treatments deserve closer scrutiny, researchers say

More research is needed to find out why some treatments (including talk therapy and CBT) are effective for some but not others, they say.

A Denver woman, right, going through a psychological evaluation with clinical psychologist.
REUTERS/Rick Wilking

We need to put more effort and resources into developing a better understanding of how psychological therapy  — “one human being talking to another” — is able to alter brain activity and cure or help ease the symptoms of many mental disorders, according to a commentary published Thursday in the British science journal Nature.

“It is time to use science to advance the psychological, not just the pharmaceutical, treatment of those with mental-health problems,” write Emily Holmes, a clinical psychologist and program director of the Medical Research Council Cognition & Brain Sciences Unit in Cambridge, England; Michelle Craske, director of the Anxiety Disorders Research Center at the University of California, Los Angeles; and Ann Graybiel, a neuroscientist at the McGovern Institute for Brain Research at the Massachusetts Institute of Technology (MIT).

As the three researchers point out, “Psychological treatments have been subjected to hundreds of randomized clinical trials and hold the strongest evidence base for addressing” many mental-health conditions, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), eating disorders, schizophrenia and depression.

Yet, “for many people, psychological treatments still conjure up notions of couches and quasi-mystical experiences,” the researchers add.

Some treatments still ‘in their infancy’

That’s not to say that psychological treatments always work.

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“Although the majority of patients benefit, only about half experience a clinically meaningful reduction in symptoms or full remission, at least for the most common conditions,” Holmes, Craske and Graybiel point out. “For example, although response rates vary across studies, about 60% of individuals show significant improvement after [cognitive behavioral therapy] for OCD, but nearly 30% of those who begin therapy do not complete it. And on average, more than 10% of those who have improved later relapse. For some conditions, such as bipolar disorder, psychological treatments are not effective or are in their infancy.”

To better understand why certain psychological therapies work for some people and not for others and to improve the treatments’ outcomes so that they help more individuals, much more scientific research is needed, say the commentary’s authors.

“Neuroscience is shedding light on how to modulate emotion and memory habit and fear learning,” they add. “But psychological understanding and treatments have, as yet, profited much too little from such developments.”

Too much professional isolation

A big part of the problem is that neuroscientists, clinical psychologists and psychiatrists tend to work in their own academic and research silos, and thus “meet infrequently, rarely work together, read different journals, and know relatively little of each other’s needs and discoveries,” say Holmes, Craske and Graybiel.

That “culture gap” must be bridged, they stress.

In addition, they say, research on psychological treatments is “scandalously under-supported”:

Mental-health disorders account for more than 15% of the disease burden in developed countries, more than all forms of cancer. Yet it has been estimated that the proportion of research funds spent on mental health is as low as 7% in North American and 2% in the European Union.

Within those slender mental-health budgets, psychological treatments receive a small slice — in the United Kingdom less than 15% of the government and charity funding for mental-health research, and in the United States the share of National Institute of Mental Health funding is estimated to be similar. Further research on psychological treatments has no funding stream analogous to investment in the pharmaceutical industry.

This Cinderella status contributes to the fact that evidence-based psychological treatments, such as CBT, [interpersonal therapy], behaviour therapy and family therapy, have not yet fully benefitted from the range of dramatic advances in the neuroscience related to emotion, behaviour and cognition. Meanwhile, much of neuroscience is unaware of the potential of psychological treatments.

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‘Enormous promise’

Holmes, Craske and Graybiel offer a multi-step process for fixing this problem, including building much stronger professional links between clinical and laboratory researchers.

In addition, they urged mental-health charities work harder to get national funding organizations “to reconsider the proportion of their investments in mental health relative to other diseases.”

“The amount spent on research into psychological treatments needs to be commensurate with their impact,” they stress.  “There is enormous promise here. Psychological treatments are a lifeline to so many — and could be to so many more.”

You can read the commentary in full on the Nature website.